title: Economic analysis and review of the literature on implant-based breast reconstruction with and without the use of the acellular dermal matrix.
abstract: BACKGROUND
  Use of the acellular dermal matrix (ADM) in two-stage implant-based breast reconstruction has been widely adopted. Despite an increasing focus on health care costs, few reports have addressed the financial implications of ADM use. This study sought to examine the costs of the two-stage technique with and without ADM, concentrating on the direct variable costs of patient care during the expansion process.
  
  
  METHODS
  A retrospective review of a prospectively maintained database was conducted. Data were collected on 132 cases resulting in a second-stage exchange for a permanent implant. The findings showed that AlloDerm was used in 61 reconstructions and Strattice in 23 reconstructions. The primary outcome was the number of fills required to achieve the final expander fill volume. The cost of subsequent patient encounters for expansion was estimated using institutional cost data.
  
  
  RESULTS
  The number of fills required to achieve the final volume was higher in the non-ADM group (6.5 ± 1.7) than in the ADM group (3.6 ± 1.4) (p < 0.0001). No significant difference was found in the small fill volumes (<350 ml; 5.3 vs. 3.7; p > 0.05). The difference was significant in the larger fill volumes (>500 ml; 8.3 vs. 3.7; p < 0.05). Relative to non-ADM reconstruction, with AlloDerm at current prices, the cost increase ranged from $2,727.75 for large reconstructions to $3,290.25 for small reconstructions ($2,167.75-$2,739.25 with Strattice).
  
  
  CONCLUSIONS
  The use of ADM in two-stage reconstruction reduces the number of visits required for reconstructions with 350 ml or more. However, at current pricings, the direct cost of ADM use does not offset the cost savings from the reduced number of visits.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Department of Surgery, Section of Plastic and Reconstructive Surgery, University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL, 60637, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Bank
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Phillips
authors.forename: Julie E
authors.initials: JE
authors.lastname: Park
authors.forename: David H
authors.initials: DH
authors.lastname: Song
mesh_terms: D062088:Acellular Dermis / Q000191:economics*; D000328:Adult; D000368:Aged; D019928:Breast Implantation / Q000191:economics* / Q000379:methods; D018427:Breast Implants / Q000191:economics*; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery; D003094:Collagen / Q000191:economics*; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D006801:Humans; D016462:Mammaplasty / Q000191:economics / Q000379:methods; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D011475:Prosthesis Failure; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014481:United States
chemical_list: C440568:Alloderm; D003094:Collagen